Lusitano's  Rules  for  Physicians 


A.     LEV  I  N  SO  X,   .M.I). 

CHICAGO 


ted  ] rum  the  Bulletin  of  the  Society  of  Medical  History  of  Chicago, 

April,  W21,  I'ol.  II,  pp.  260-263 


RULES     FOR     PHYSICIANS* 
A.    LEVINSON,    M.D. 

CHICAGO 

The  rules  for  physicians,  authorship  of  which  is  credited  to  Lusi- 
tano,  are  contained  in  two  Hebrew  medical  treatises.  One  of  the 
treatises,  Ozar  Hachaim  ("The  Treasure  of  Life"),  published  in 
Venice  in  1683,  was  written  by  Jacob  Zaholon.  The  other,  called  Har- 
monia  Wallichia  Medico,  published  in  Frankfort  am  Main,  in  1700, 
was  written  by  Abraham  Wallich.1  Zaholon's  book  is  purely  medical, 
while  Wallich's  treatise  is  a  combination  of  medicine  and  religious 
philosopy,  a  type  of  literary  fusion  quite  common  in  medical  writings 
of  the  middle  ages. 

The  rules  given  in  the  two  treatises  differ  somewhat,  Wallich 
giving  only  fifty  whereas  Zaholon  gives  seventy-six.  In  the  main, 
however,  they  are  the  same.  Zaholon  gives  Lusitano's  full  name  as 
Abram  Zakuto  Lusitanus,  while  Wallich  speaks  of  him  only  as  Zakuto 
Lusitanus.  In  the  work  of  these  two  authors  as  well  as  in  other 
Hebrew  works  his  name  is  spelled  Lusitanus  with  the  "us"  ending, 
while  in  the  English  translation  of  Graetz  his  name  is  spelled  Lusitano. 

Neither  of  the  authors  tells  when  Lusitano  lived.  According  to 
Graetz  he  was  born  in  1576  and  died  in  1642.  He  was  the  great- 
grandson  of  Zacuto,  the  historian  and  astronomer.  He  was  one  of 
the  most  celebrated  physicians  of  his  time  and  was  honored  by  his 
professional  brethren. 

It  should  be  noted  that  the  Lusitano  under  discussion  is  not  Amatus 
Lusitano  or  Lusitanus,  the  Portuguese  physician  of  the  sixteenth  cen- 
tury who  was  born  in  1511  and  died  in  1568  and  who  was  known  for 
his  seven  books  of  case  histories  which  appeared  under  the  general 
title  of  "Centuries."  Since  Zaholon  deals  more  exhaustively  with  the 
subject  I  shall  quote  his  version  of  Lusitanus'  rules  for  physicians. 

I  shall  present  the  rules  in  the  exact  numerical  order  in  which  they 
appear,  although  in  many  instances  a  rearrangement  would  make  for 
more  logical  sequence. 

1.  The  physician  should  he  pious. 

2.  He  should  he  dressed  well. 

3.  He  should  not  talk  (too)  much. 

4.  He  should  not  be  too  economical    (parsimonious). 

5.  He  should  not  insist  on  his  fee. 


*  Read  at  a  meeting  of  the  Society  of  Medical  History  of  Chicago.  Dec.  10, 
1920. 

1.  For  permission  to  use  the  original  Hebrew  text  I  am  indebted  to  Prof. 
Alexander  Marx,  librarian  of  the  Jewish  Theological  Seminary  of  Xeu  York 


20694  P5 


2  A.  Levinson 

6.  He  should  not  be  envious. 

7.  He  should  not  be  vain. 

8.  He  should  not  be  willful  toward  his  superiors. 

9.  He  should  admit  his  mistakes. 

10.  He  should  accept  cheerfully  the  censure  of  his  elders. 

11.  He  should  be  well  disposed. 

12.  He  should  have  common  sense. 

13.  He  should  study  every  subject  thoroughly. 

14.  He  should  buy  few  books,  but  good  ones  for  the  study  of  medicine. 

15.  He  should  peruse  the  books  of  learned  and  practical  men. 

16.  He  should  not  undertake  to  cure  the  incurable. 

17.  He  should  refrain  from  making  false  promises. 

18.  He  should  not     exaggerate  a  (slight)  illness. 

19.  He  should  not  make  light  of  a  serious  illness. 

20.  He  should  be  willing  to  consult  with  other  physicians. 

21.  He  should  limit  himself  to  but  a  few  patients,  for  the  care  of  too 

many  breeds  mistakes. 

22.  He  should  not  pay  much  attention  to  the  name  of  the  disease,  but  to 

its  character  and  treatment. 

23.  He  should  not  make  light  of  anything  for  even  from  small  things  one 

may  be  able  to  obtain  a  clue. 

24.  He  should  not  be  slow  in  giving  the  proper  medication. 

25.  He  should  not  do  anything  without  reason. 

26.  He  should  be  careful  about  giving  a  prognosis  so  that  he  may  not  be 

caught  in  a  falsehood. 

27.  He  should  not  make  any  promises. 

28.  He  should  do  everything  according  to  medical  teachings  (ethics). 

29.  He  should  combine  experience  and  reasoning  in  his  practice. 

30.  He  should  be  quick  in  action  and  not  sloth  in  time  of  need. 

31.  He  should  consider  the  value  of  the  person  he  treats. 

(It  is  not  clear  whether  he  refers  to  the  financial  status  of  his  patient  or  to 
the  value  of  a  human  life  in  general.) 

32.  His  principal  aim  should  be  the  cure  of  his  patient. 

33.  He  should  consider  the  difficulties  and  the  dangers  of  the  cure. 

34.  He  should  not  fear  the  wrath    (censure?)   of  people. 

35.  At  times  he  should  entertain  the  patient  with  pleasant  conversation. 

36.  He  should  institute  the  cure  quickly  and  unhesitatingly. 

37.  He  should  not  deviate  from  the  logical  treatment  even  if  the  antici- 

pated cure  is  not  obtained. 

38.  He  should  use  common  sense  in  purgation. 

39.  In  giving  counsel  he  should  follow  the  rules  of  medicine  and  observe 

the  working  of  Nature. 

40.  When  Nature  does  not  effect  the  physician  should  try  to  do  so  by 

means  of  medicine. 

41.  If  Nature  is  bringing  about  a  cure  he  should  not  do  anything. 

42.  On  the  day  that  Nature  is  expected  to  work  a  change  in  the  condi- 

tion the  physician  should  not  do  anything. 

43.  He  should  be  careful  to  administer  medicine  on  the  right  day  and  at 

the  right  hour. 

44.  He  should  not  give  strong  purgatives  unless  other  remedies  have  not 

done  any  good. 

45.  Before  giving  a  purgative  he  should  prepare  the  body  humors   in 

order  to  make  it  easier  to  purge  them. 

46.  He  should  always  start  with  the  lighter  remedies. 

47.  He  should  select  the  proper  time  for  purging. 

48.  He  should  keep  in  mind  the  signs  of  the  astrologists  as  to  which 

day  is  good  and  which  is  bad  for  purging  or  blood  letting. 


Lusitano's  Rules  3 

49.  In  blood  letting  he  should  consider  the  nature  of  his  patient — whether 

he  is  warm  or  cold-blooded. 

50.  He  should  find  out  whether  the  patient  can  stand  a  strong  purgative. 

51.  He  should  keep  in  mind  the  movements  of  the  body  fluid,  the  point 

from  which  it  moves. 

52.  He  should  consider  the  character  of  the  humors  that  need  purging. 
51.  He  should  take  into  consideration  the  habits  of  the  patient  in  purg- 
ing him. 

54.  He  should  also  note  the  disposition  of  the  fluids  by  the  body  whether 

they  come  from  above  or  from  below  or  through  sweating. 

55.  He  should  not  employ  drugs  in  every  illness,  for  at  times  if  the  ill- 

ness is  slight  and  the  patient  is  not  strong,  a  change  in  diet  may 
suffice. 

56.  A  disposed  body  is  preserved  by  a  like  remedy,  a  non-disposed  body 

by  its  opposite. 

57.  Bad  humors  should  not  be  removed  from  the  diseased  part  of  the 

body. 

58.  A  chronic  illness  is  sometimes  cured  by  a  change  in  the  patient's 

surroundings. 

59.  The  physician  should  assist  Nature,  for   it  is  the  most   important 

factor  in  health. 

60.  He  should  observe  closely  the  strength  of  the  patient,  particularly 

the  condition  of  his  brain. 

61.  He  should  endeavor  to  discover  what  part  of  the  body  is  diseased. 

62.  He  should  find  out  which  is  the  primary  disease  and  which  the  sec- 

ondary one. 

63.  If  he   does   not  diagnose   the   trouble   he   should   treat   the  patient 

dietetically. 

64.  He  should  learn  what  is  helpful  to  the  patient  and  what  injurious. 

65.  He  should  study  the  changes  of  locations    (changes   in  climate  or 

changes  in  location  of  disease?)  for  remedies  must  change 
accordingly. 

66.  He  should  direct  the  remedy  to  meet  the  most  dangerous  (symptom?) 

67.  He  should  not  give  a  strong  purgative  at  the  beginning  of  the  dis- 

ease before  the  humors  are  ripe  for  it. 

08.  He  should  not  become  alarmed  if  severe  symptoms  appear,  for  that 

marks  the  critical  period. 

09.  Among  the  symptoms  to  be  treated  early  is  pain,  for  pain  under- 

mines the  patient's  strength. 

70.  He  should  treat  deep  somnolence  or  persistent  insomnia. 

71.  He  should  not   administer  a  purgative   from   distant   places    in  the 

body  until  the  bowels  have  moved. 

72.  In    administering    drugs    he    should    keep    in    mind    the    difference 

between  a  male  whose  nature  is  warm  and  strong  and  a  female 
whose  nature  is  cold  and  strong,  for  to  her  only  few  and  light 
remedies  should  be  given. 

73.  He  should  be  careful  in  giving  medicine  to  young  and  to  very  old 

both  of  whom  are  weak. 

74.  He  should  be  very  careful  in  treating  infants. 

75.  He  should  know  the  anatomy  of  different  parts  of  the  body. 

76.  He  should  learn  surgery. 

77.  He  should  learn    the    properties    and   the   compounding    of   various 

drugs. 

Zaholon  supplements  the  golden  rules  of  Lusitano  with  some  addi- 
tional advice.  Whether  the  advice  is  his  own  or  whether  it  is  still  a 
continuation  of  the  counsel  of  Lusitano  is  not  plain,  but  the  suggestions 
are  worth  while  irrespective  of  the  source.  In  the  translation  that 


4  A.  Levinson 

follows  I  have  tried  to  preserve  the  original  uniqueness  of  the  style  as 
closely  as  possible: 

It  is  very  good  that  at  the  beginning  of  his  practice  the  physician  should 
go  around  with  an  older  (wise)  physician  to  visit  patients,  and  as  soon 
as  he  comes  home,  he  should  mark  down  the  remedies  that  he  has  heard 
from  the  older  physician  and  he  should  also  read  up  the  case  in  different 
books  to  clear  up  any  doubts  he  might  have  about  it. 

When  a  doctor  comes  to  a  patient,  he  should  not  take  the  pulse  immedi- 
ately but  should  rest  up  a  bit,  and  should  ask  the  patient  or  his  relatives  how 
the  disease  started,  and  should  inquire  first  about  his  head,  whether  or  not 
he  has  a  headache,  whether  he  sleeps  well,  whether  he  is  thirsty,  whether 
he  has  pain  anywhere,  whether  he  eats  or  drinks ;  he  should  then  look  at 
his  tongue  and  examine  his  urine  and  take  the  pulse.  Then  he  should  give 
orders  what  should  be  done,  in  the  same  manner  that  a  king  commands  his 
subjects ;  To  poor  people  he  should  give  effective  but  inexpensive  remedies ; 
to  rich  people  he  should  give  pleasant  and  expensive  remedies.  It  is  also 
best  that  he  write  down  the  remedies  in  order  that  the  people  should  not 
forget,  as  might  happen  if  he  gave  verbal  orders.  It  is  also  more  impressive 
if  the  physician  writes  down  his  orders.  At  times  it  is  well  to  explain  the 
reasons  for  the  remedies  but  not  the  nature  of  the  remedy  that  people  may 
not  become  disgusted  with  them.  He  should  not  make  the  disease  hard  in 
order  not  to  worry  the  people,  but  he  should  put  the  matter  in  a  doubtful 
manner  giving  good  hopes :  even  if  the  disease  should  be  severe  he  should 
tell  the  patient  himself  that  the  illness  is  slight,  and  that  others  who  have 
had  the  same  sickness  recovered. 

If  he  hears  of  a  good  remedy  from  another  physician,  he  should  not  make 
light  of  it.  and  if  there  is  another  physician  with  him,  he  should  not 
belittle  his  words,  whether  they  are  good  or  bad.  at  least  he  should  not 
give  his  opinion  of  them  in  the  presence  of  others. 

If  the  patient  has  a  bad  disease,  the  physician  should  not  come  too  close 
to  him:  likewise  if  the  patient  has  a  bad  odor. 

When  the  patient  gets  well  the  doctor  should  excuse  himself  and  should 
not  call  on  him  (the  patient)  too  long  if  it  is  unnecessary. 

He  should  leave  instructions  as  to  how  the  patient  should  conduct  himself 
after  he  gets  well  in  order  that  the  disease  should  not  repeat  itself,  and  he 
should  thank  God  for  curing  the  patient.  If  necessary  he  should  visit  the 
patient  more  than  twice  a  day. 

The  physician  should  not  give  out  the  medicine  himself,  but  should  send 
the  patient  to  an  apothecary.  At  times  he  should  be  present  during  the 
blood  letting.  He  should  not  think  of  expense  but  of  what  is  useful  for  the 
health  of  the  patient,  and  before  he  orders  the  medicine  he  should  pray  to 
God  to  instruct  him  in  giving  the  proper  medicine.  If  he  sees  that  the 
patient  is  dangerously  ill.  he  should  tell  the  relatives,  so  that  if  the  patient 
should  die  they  will  not  think  ill  of  him;  he  should  do  this  also  so  that  they 
may  be  able  to  do  everything  they  can  for  the  patient  without  caring  for 
expense.  When  a  physician  treats  women,  he  should  be  modest.  He  should 
also  inquire  whether  the  patient  menstruated  or  whether  she  is  pregnant. 

He  should  not  accept  remuneration  from  poor  people,  from  relatives,  or 
from  good  friends,  nor  should  he  accept  any  money  on  the  Sabbath  or  holi- 
days. If,  however,  he  treats  a  friend  who  wants  to  pay  him  every  day  so 
that  he  should  not  have  to  give  him  an  expensive  present  at  the  end,  or  that 
he  may  feel  free  to  call  on  him.  he  should  accept  a  fee,  for  though  it  is 
true  that  a  physician  does  the  work  of  God,  and  should  not  accept  any 
money,  still  he  can  do  the  same  as  a  teacher  and  accept  remuneration  for 
his  time,  also  that  he  may  be  able  to  make  a  living  in  the  profession,  and 
also  because  as,  the  saying  goes,  "a  physician  who  works  for  nothing  is 
worth  nothing."  Once  a  week  also  he  should  say  a  prayer  for  physicians 
that  I  have  written  in  my  book,  "Good  Pearls,"  published  in  Venice. 


ERTER'S     SATIRE    ON     DOCTORS* 
A.    LEVINSON 

CHICAGO 

Among  the  interesting  satires  on  doctors  should  be  included  one 
which  appeared  in  the  early  nineties  of  the  last  century.  It  was  written 
in  Hebrew  by  Isaac  Erter,  a  Galician  physician.  I  shall  present  a 
translation  and  interpretation  of  a  few  of  the  most  interesting  por- 
tions of  the  book  which,  in  addition  to  the  satire,  contains  visions  and 
revelations  made  to  the  author  by  a  spirit.  The  spirit  is  made  the 
mouthpiece  of  the  author's  criticisms  all  through  the  book. 

The  author,  who  is  critical  of  existing  conditions,  discusses  the 
status  of  the  physician  of  his  day.  In  one  of  his  chapters  he  tells  of 
his  encounter  with  a  spirit  who  flew  out  of  one  of  his  patients  at  the 
time  of  his  death.  The  spirit  enters  into  a  lengthy  conversation  with 
the  physician,  in  the  course  of  which  he  gives  him  some  pointed  advice 
on  the  art  of  his  conduct  as  a  physician.  In  what  he  designates  as 
the  ten  golden  chapters  he  lays  down  several  practical  rules  by  which 
the  physician  should  guide  himself  in  dealing  with  his  patients : 

"The  spirit  said  unto  me,"  says  Erter,  "You  are  a  physician ;  you 
live  among  people,  but  you  do  not  know  the  soul  of  the  people.  You 
do  not  know  the  rabble  among  them.  People  judge  you  by  appearance 
only.  Their  measure  of  your  knowledge  depends  on  the  beauty  of 
your  apartment,  the  bounty  of  your  table,  the  number  of  servants  in 
your  household,  the  appearance  of  your  clothes  and  furniture.  If  a 
donkey  puts  on  nice  clothes,  and  holds  his  head  aloft,  he  is  considered  a 
wise  and  learned  creature.  I  know  all  this  and  I  have  therefore 
become  rich  and  mighty.  •  Hippocrates  wrote  his  aphorisms  in  books, 
and  one  who  gets  sick  may  become  well  by  following  his  axioms.  I 
have  written  chapters  better  than  his  in  a  book,  chapters  and  rules 
which  a  doctor  should  follow  if  he  desires  to  live.  Pythagoras  called 
his  aphorisms  the  Golden  Aphorisms,  an  improper  name,  for  what 
have  his  aphorisms  to  do  with  gold.  They  are  moral  lessons,  wise 
sayings,  but  not  golden  sayings.  My  chapters  I  properly  call  the 
Golden  Chapters,  for  through  them  even  a  donkey  who  undertakes  the 
task  of  healing  can  fill  his  bags  with  gold.  A  few  of  these  chapters 
I  shall  let  you  read,  and  if  you  will  be  attentive  and  observe  them, 
you  too  will  succeed !" 

The  author  then  quotes  the  Golden  Chapters  which  the  spirit 
entrusted  to  him.  The  translation  follows : 


*  Read  at  a  meeting  of  the  Society  of  Medical  History  of  Chicago,  Dec.  10, 
1920. 


A.  Levinson 

THE     GOLDEN     CHAPTERS 

A.  Whiten  your  hair  with  dust,  and  put  a  camel's  pillow  on 
your  stomach.    You  will  then  be  considered  wise  by  all  who  look 
upon  you,   for  they  will  say,   "Great  problems  turned   his   hair 
white,  and  his  learning  is  within  him." 

B.  Put  a  human  skull  on  your  table,  and  a  stillbirth  without 
head  or  foot  in  a  glass  jar  preserved  in  alcohol  on  your  window. 
All  who  will  visit  you  will  look  at  them  and  will  marvel  at  your 
wisdom. 

C.  Buy  countless  numbers  of  books,  dress  them  up  in  skin 
dresses  (sheepskin),  and  cover  their  backs  and  their  margins  with 
gold.     Then  put  them  in  a  case  and  lock  them  up,  never  to  be 
read ;  but  transparent  glass  should  you  put  in  the  doors  of  your 
bookcase.     People  will  see  your  beautiful  books  and  will   say, 
"There  is  no  end  to  your  wisdom." 

D.  Pawn  everything  you  have  to  buy  yourself   fine  horses. 
Let  the  loan  shark  go  after  you,  but  buy  yourself  a  carriage,  for 
even  though  you  kill  all  people  like  one  man,  if  your  horses  and 
chariot  stand  in  front  of  the  door,  all  who  pass  by  will  say,  "He 
cures  everybody ;  he  is  truly  wonderful." 

E.  When  you  come  to  the  house  of  a  patient,  do  not  worry 
about  his  sickness,  but  look  at  the  people  who  stand  by  his  bed 
and  bethink   yourself   what  to   say   to  them.      On   parting  you 
should  say,  "I  do  not  believe  he  will  survive,"  so  that  if  the 
patient  dies,  they  will  all  say,  "Did  not  the  doctor  say  so?     He 
understood  it  all."     If  on  the  other  hand  the  patient  gets  well, 
they  will  not  say  he  did  not  understand,  but  will  exclaim  with 
astonishment,  "He  returned  soul  to  a  corpse." 

F.  Poor  people  usually  look  for  medical  aid  only  when  they 
reach  the  gates  of  death.     To  cure  a  poor  man  is  very  hard.     If 
he  lives,  he  does  not  pay  you  for  your  work,  and  what  reward 
is  there  if  he  dies,  except  that  your  name  is  connected  with  his 
death.     Therefore,  keep  them  away  from  you.     Do  that  diplo- 
matically.    When  you  talk  to  them,  raise  your  voice,  show  them 
your  superiority.     They  will  be  frightened,  and  will  not  come 
near  you. 

G.  Set  aside  a  certain  time  for  poor  people  to  come  to  you 
for  consultation.     Let  therp  stand  in  the  doorway  of  your  house, 
and  whoever  passes  by  and  sees  them  will  say,  "Behold,  he  is  a 
great  and  renowned  physician.     People  from  all  over  rap  at  his 
doors."     Pick  out  only  the  rich  people  who  come  at  the   same 
time,  take  them  first,  examine  them,  prescribe  for  them,  talk  to 
them,  and  take  their  money,  and  when  the  rich  people  leave,  tell 
the  poor  people  who  stand  outside  to  come  tomorrow,  today  it 
is  too  late,  they  cannot  come  in  any  more. 

H.  Your  colleagues  are  robbing  you  of  your  bread.  There- 
fore, belittle  them.  Throw  mud  at  them.  Speak  only  bad  of 
them.  Show  up  their  faults.  There  is  no  such  thing  as  another 
good  doctor.  If  your  rival  happens  to  read  journals  and  history, 
say  that  he  occupies  his  time  with  other  things.  When  he  comes 
to  a  patient,  report  that  he  pays  no  heed  to  the  sickness,  that  he 
is  concerned  at  that  moment  with  the  politics  of  Great  Britain, 


Erter's  Satire 

or  France  or  Spain.  If  your  colleague  is  young,  you  should  say, 
"He  is  too  young,  he  has  not  had  the  experience  I  have  had,  he 
will  have  a  great  deal  to  learn  before  he  will  be  a  doctor."  If, 
on  the  other  hand,  your  colleague  is  older  than  you,  you  should 
say  he  is  too  old,  his  eyes  do  not  serve  him  any  more ;  his  mind 
does  not  work  well  any  more. 

I.  If  your  colleague  calls  you  for  consultation,  and  he  tells 
you  what  he  did  for  the  patient  until  the  time  you  came  in,  you 
should  turn  up  your  nose  and  your  lips,  your  face  should  bespeak 
your  dissatisfaction  with  what  has  been  done,  and  if  the  bystanders 
do  not  understand  your  heart's  thoughts,  you  should  speak  up 
and  tell  the  doctor,  in  the  presence  of  the  others,  "Why,  you 
have  done,  the  wrong  thing  for  the  patient;  your  ways  are  the 
ways  of  death."  In  such  a  manner  your  enemy  will  be  doomed, 
and  you  will  be  up  in  the  skies,  for  if  the  patient  dies,  it  will  be 
the  fault  of  your  enemy.  If  he  gets  well,  you  have  done  wonder- 
ful things  by  delivering  him  from  death  through  your  wisdom. 

J.  When  somebody  calls  another  physician  as  a  consultant  in 
your  case,  do  not  heed  the  consultant's  words,  for  if  you  do  the 
patient  may  get  well  and  you  will  be  shown  up.  If  you  see,  how- 
ever, that  there  is  no  hope  for  the  patient,  then  listen  to  the 
consultant's  words,  and  take  his  advice  so  that  when  the  patient 
dies  you  will  say,  "I  am  not  to  blame;  the  patient  died  through 
the  fault  of  my  consultant,"  and  the  people  will  believe  you. 


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